MEDICARE: DR. FRANCIS J KUBIK III DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	13490	MO

General Provider Information

NPI Number	:	1851302442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANCIS J KUBIK III DDS

Provider Business Mailing Address
First Line	:	100 NORTH EUCLID
Second Line	:	SUITE 410
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1529
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N EUCLID AVE
Second Line	:	SUITE 410
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1529
Country	:	US
Telephone Number	:	314-361-7700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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